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GI Screening: Racing Time Or Wasting Time?

Date:

May 24, 2007

Source:

American Gastroenterological Association

Summary:

Preventative medicine and technology are some of the great benefits in this ever-changing age of health-care technology. Operations that once required major surgery and in-patient stays are being replaced with minimally invasive procedures with quick recovery times. Among these preventative technologies include CT scans, colonoscopies and X-rays. But with all of these available options in detecting abnormalities in patients, how does one choose which test to perform and whether it is worth the time to test on fast-acting ailments?

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Preventative medicine and technology are some of the great benefits in this ever-changing age of health care technology. Operations that once required major surgery and in-patient stays are being replaced with minimally invasive procedures with quick recovery times. Among these preventative technologies include CT scans, colonoscopies and X-rays.

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But with all of these available options in detecting abnormalities in patients, how does one choose which test to perform and whether it is worth the time to test on fast-acting ailments? Research presented today at Digestive Disease Week® 2007 (DDW®) provides guidance as to which tests are best for which patients. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

"The findings from these studies direct doctors as to what measures are most effective in treating their patients," said Gregory Ginsberg, M.D., AGAF, University of Pennsylvania Health System. "Whether the patient's condition is acute or chronic, detection and time are crucial factors in patient outcome."

Computed Tomography in Diagnosis of Acute Appendicitis: Definite or Detrimental?

It can be difficult to assess whether a patient is experiencing acute appendicitis or has an intestinal upset. CT, or computed tomography, scans can help determine if the patient needs to have his or her appendix removed. However, while having a clear picture showing the appendix confirms patient and physician suspicions, the time required to conduct the scan delays time to a potential operation, with the risk that the appendix could perforate while the patient awaits the test results. Researchers at the University of Wisconsin in Madison, Wis. evaluated the differences between patients who received a CT scan before removal of their appendix and those who went directly to surgery without the test.

In this study, investigators reviewed the hospital records for 412 adult patients admitted to University of Wisconsin Hospital during a three-year period. The researchers compared the white blood cell counts taken from patients both upon arrival to the emergency room and at the operating room. Of the 410 patients showing signs of acute appendicitis, more than half (62%) had a CT scan before the removal of their appendix.

Patients who were ordered a CT scan were older, more likely to be female and had experienced a longer waiting period between admittance and surgery than those who were not ordered a scan (8.2 vs. 5.1 hours). Additionally, perforation was seen in 17 percent of those who had a CT scan, while only eight percent of those who did not get a CT scan experienced perforation.

"These findings suggest that pre-operative CT scanning in patients experiencing acute appendicitis symptoms should be used selectively," said Herbert Chen, M.D., of University of Wisconsin and lead author of the study. "CT imaging may delay surgery, increasing the likelihood of the appendix rupturing and causing potentially dangerous complications for the patient."

The Utilization of Colonoscopy as a Screening Method For Colorectal Cancer

When screening for colorectal cancer, there are many different test options; however, there has been no consensus on the most appropriate screening method for specific subsets of patients. In this study, researchers evaluated tests to detect advanced neoplastic lesions (lesions with high risk of progression to cancer or actual cancer), seeking to identify possible racial disparities between Caucasian and African American patients in detecting and diagnosing colorectal cancer, as well as the usefulness of colonoscopies in detecting colorectal cancer in patients without cancerous symptoms.

Investigators reviewed 16,737 colonoscopies performed at Emory University Hospital and Grady Memorial Hospital between January 2000 and December 2005. Colonoscopies give clearer pictures of bends in the colon than another screening tool called flexible sigmoidoscopy, which uses a slender hallow lighted tube to detect cancer. Researchers studied procedure results for abnormally sized and shaped polyps and adenomas (benign tumors) larger than 10 millimeters.

One-third (n=5,597) of the patients screened had an average risk for colorectal cancer and eight percent (n=462) were confirmed to have advanced neoplastic lesions. For more than half of the patients with advanced neoplastic lesions (57%, n=262), the lesions were confined to the proximal colon, making it very difficult for the flexible sigmoidoscopy to detect. Notably, Caucasian patients had a higher risk for proximal tubular adenoma while African American patients had a higher risk for proximal adenocarcinoma and proximal tubulovillous adenoma. Tubulovillous adenomas have a higher rate of progression to cancer. There was a trend towards females having more advanced neoplastic lesions. However, this was not statistically significant.

"These results direct doctors to perform colonoscopies rather than other methods, such as the flexible sigmoidoscopy, as they detect more colon tumors that may have been missed with flexible sigmoidoscopy," said Mohammed A. Wehbi, M.D., of Emory University in Atlanta, Ga., and lead author of this study. "Additionally, the study shows racial differences in detecting and diagnosing advanced neoplastic lesions/cancer, suggesting a possible need for earlier and more aggressive screening of African American patients."

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